- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.50 / $188.50 / $359.55
| Professional | | $188.50 | $188.50 | $359.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.06 / $167.65 / $198.03
| Professional | | $159.06 | $167.65 | $198.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.00 / $85.26 / $118.59
| Professional | | $71.00 | $85.26 | $118.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.31 / $239.11 / $326.55
| Professional | | $152.31 | $239.11 | $326.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.23 / $132.40 / $238.33
| Professional | | $109.23 | $132.40 | $238.33 |